Remote Clinical Performance Auditor

Centene Management Company LLC; Town of Florida (NY); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements (remote, hy

Benefits subject to program

Job summary

Centene Management Company LLC is seeking a remote Performance Monitoring Specialist, Clinical to join the Care Management clinical auditing team. You will audit care management member interactions by reviewing call recordings and related documentation to ensure compliance with organizational policies and contractual requirements.

The role requires nursing or clinical social work/counseling backgrounds, years of clinical experience, and familiarity with Medicare/Medicaid programs.

Qualifications

• Bachelor's Degree in Nursing or Associate's degree and an RN with 3+ years of clinical experience.
• 3+ years of experience in a clinical environment (inpatient or outpatient).
• 1+ year of experience in Managed Care (UM, BH, CM) preferred.
• Familiarity with Medicare and Medicaid programs preferred.

Responsibilities

• Conducts clinical file assessments by reviewing clinical documentation as assigned.
• Develops and reviews clinical review tools to ensure that clinical elements accurately capture adherence with required performance standards.
• Reviews policies, procedures, and state contracts to align tool elements with standards.
• Evaluates documentation of member health assessments and interventions for compliance.
• Escalates concerns identified during clinical file reviews and prepares for audits as needed.
• Maintains productivity and IRR standards for file reviews.
• Follows departmental guidelines and processes.
• Performs other duties as assigned.

Education

Bachelor's Degree in Nursing

Associate's degree and an RN with 3+ years of clinical experience

Job description

Centene Management Company LLC is seeking a remote Performance Monitoring Specialist, Clinical to join the Care Management clinical auditing team. You will audit care management member interactions by reviewing call recordings and related documentation to ensure compliance with organizational policies and contractual requirements.

The role requires nursing or clinical social work/counseling backgrounds, years of clinical experience, and familiarity with Medicare/Medicaid programs.